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Wednesday, August 13, 2014

The Nutrition Debate #235: Self- vs. medical management of T2DM

1,750,000 “hits” on the subject of self-management
of type 2 diabetes in my initial Google search; that’s lots of advice, the vast
majority of which is, in my humble opinion, really bad. So, in this sea of
flotsam and jetsam, there wouldn’t be much chance of your finding my little
rubber ducky (#235). Besides, this post is going to show you how almost anywell-designed
program of self management of type 2 diabetes is far superior to any
ADA/AHA/AMA/USDA designed protocol. The differences will astound you, I
promise. And the benefits to you,
“the patient,” will be demonstrable.

To show superiority, we will need a basis for
comparison. In the case of type 2 diabetes, that would be the Standard of Care
set by the American Diabetes Association.They, in turn, will comply with the government’s standards of
“insurance” reimbursement for Medicare and Medicaid patients, to which private
insurers also generally conform. And since type 2 diabetes is a medical
condition that is generally associated with a raft of other disorders and
conditions, including obesity, metabolic syndrome, dyslipidemia, hypertension,
and cardiovascular disease, the Standards of Care and standards of insurance
reimbursements for these conditions must also be factored.

So, when you “present” as an overweight middle-aged
person, with elevated fasting glucose (>100 but <126mg/dL) or an A1c that
is “increased risk of diabetes” (5.7-6.0%) or “higher risk of diabetes”
(6.1-6.4%), if you’re lucky, you’re given metformin and told to “lose weight.”
Not so lucky and you’re only told, “Your glucose is a little high” and “We’ll
watch it.”

You’re probably already on a cocktail of blood
pressure meds for your obesity-related hypertension, and if you’ve been eating
a low-fat, high-carb diet as recommended by the Dietary Guidelines for
Americans since 1977, you probably also have high triglycerides, low HDL, and
high LDL, with a total cholesterol over 200mg/dL. So, you’re on a statin too,
to lower your LDL and Total Cholesterol (because that’s what statins do) in
conformance with the National Cholesterol Education Program (NCEP) Standard of
Care (another one of those government standards).

Your doctor, whether he or she is a general
practitioner or a specialist, has to treat you for this complex of conditions. For
example, an endocrinologist (a
hormone specialist!) that I went to see recently (without a referral), wanted
to prescribe a statin for me because my total cholesterol was over 200 (and I
have other risk factors: hypertension and type 2 diabetes). It did not matter
to him that my total cholesterol (207mg/dL) was over 200 because my HDL was 90. My
LDL was 117 and my triglycerides 34. I wonder if he knew about the Friedewald
formula: TC = LDL + HDL + TG/5. All that mattered to him was, to conform to the
NCEP Standard of Care (and insurance payment/review criteria), that I be on a
statin. I refused.

The Dietary Guidelines for Americans are similarly
one-size-fits-all. Everyone, regardless of metabolic status, should eat the
same low-fat, high carb diet. But the
pendulum is beginning to swing. Now we’re told to eat less sugar and highly
processed carbs (that’s good advice). We’re now also told that it’s the
quality, not the quantity, of fat that matters. They say shun trans fats (good
advice) and eat more vegetable and seed oil and less saturated fat (that’s bad
advice). Still, the government’s one-size-fits-all standards are way behind the
curve. In addition, they have been hopelessly corrupted by industry influence
at the USDA. It’s bad news, period.

The American Diabetes Association has similar
standards. It used to be one-size-fits all, and the Standard of Care, to
achieve an A1c of < or = to 7.0%, hopelessly lax. This catastrophic Standard
of Care was and still is a function of a failed treatment protocol. And it is a
failed treatment protocol because of the government’s insistence on a low-fat, high carb one-size-fits-all
diet for the American population. And now they want to lower the Standard of
Care. See #230 here.

Never mind that that this dietary is what has made
the population fat. Never mind that all
carbohydrates raise your blood glucose. At the very least, once you “present”
as an overweight middle-aged person, with elevated fasting glucose (>100 but
<126mg/dL) or an A1c that is at “increased risk of diabetes” (5.7-6.0%) or
“higher risk of diabetes” (6.1-6.4%), your doctor should tell you (as mine did)
to drastically curtail your intake of carbohydrates. My doctor suggested I
start on 20 grams of carbohydrate a day
to lose weight. I did. I lost lots of weight.

And I also
was able to give up virtually all of my oral diabetes meds. And my blood
pressure went from 130/90 to 110/70 on the same meds. And my HDL more than
doubled. And my triglycerides dropped by two-thirds. And I no longer, of
course, need a statin. This treatment protocol, which I self-monitor by
watching what I eat and monitoring my blood sugar to a much higher standard than prescribed by the American Diabetes
Association and my doctor, is clearly far
superior to the one-size-fits-all medical standard that our government and the
medical establishment continue to use to treat T2DM.

What’s your HDL level?Or does your doctor even care? You see, there’s no ‘magic pill’ to get
your HDL up above the 40mg/dL range, which is considered borderline ‘bad’ for
men (45mg/dL for women). Only a low-carb diet can do that. And lower your
triglycerides too.

About Me

I was diagnosed a Type 2 diabetic in 1986. I started a Very Low Carb diet (Atkins Induction) in 2002 to lose weight. I didn’t realize at the time that it would put my diabetes in clinical remission, or that I would be able to give up almost all of my oral diabetes meds. I also didn’t understand that, as I lost weight and continued to eat Very Low Carb, my blood lipids would dramatically improve (doubling my HDL and cutting my triglycerides by 2/3rds) and that my blood pressure would drop from 130/90 to 110/70 on the same meds.
Over the years I changed from Atkins to the Bernstein Diet (designed for diabetics) and, altogether lost 170 pounds. I later regained some and then lost some. As long as I eat Very Low Carb, I am not hungry and I have lots of energy. And I no longer have any of the indications of Metabolic Syndrome.
My goal, as long as I have excess body fat, is to remain continuously in a ketogenic state, both for blood glucose regulation and continued weight loss. I expect that this regimen will continue to provide the benefits of reduced systemic inflammation, improved blood lipids and lower blood pressure as well.